Why she did not ovulate inpite of using clomifin, Provigil and Duphaston?

Sir,
We are trying to conceive for the last 1 year.She had PCOD problems,her weight is 50kg and our gynaecologist suggested for follicular study for the last two cycles.She had prescribed clomifin 10mg for formation of egg.On 16th day 1 egg was formed of 20 mm then our Dr. prescribed Provigil 5000 IU twice,then she ovulated and Dr. prescribed to take Duphaston 10 mg,but she did not conceived.
In second cycle we again done the same treatment. This time on 20th day of period 2 eggs were there 24*20mm & 19*16mm and she had taken Provigil 5000IU.injection but she didnot ovulate.
Then on 22nd day she had taken the same injection but still she did not ovulated.
On 24th day eggs size were 41*35mm & 46*35mm.
Please suggest us,why she did not ovulate this time & what will happen of eggs.
regards
XXXXXXX

Brief Answer:
Can happen occasionally.
Detailed Answer:
Hi XXXXXXX
Welcome to HCM.
Non rupture of follicles can be due to two things: first, it can happen occasionaly for no reason & if its so, there should be no reason to worry. Second reason is mild adhesions around ovary either due to mild endometriosis or infection. Both can be diagnosed through laparoscopy.
As she had ovulation previously, to be on positive side, we can consider this as occasional happening & need not investigate in detail.
Regarding fate of unruptured follicles, they can either rupture spontaneously before next menses or can persist. If they persist till 3rd/4th day of menses & are seen on ultrasound, she will need a course of contraceptive pills (for around 20 days) to suppress them & you can try ovulation induction again from next to next menses.
Please remember that one cycle of ovulation induction doesn't give 100% chance of pregnancy & please continue trying for pregnancy.
Hope this helps you.
Let me know if you have other concerns.
Regards.

Follow-up: Why she did not ovulate inpite of using clomifin, Provigil and Duphaston? 2 hours later

Sir,
Thanks for reply.
Dr. has prescribed to take Duphaston 10 mg tablets for 15 days.And told,if period comes then on 2nd day of period go for sonography.
I want to know,whether duphaston will result in period, as my wife's periods are irregular.
Also I want to know whether those eggs will included in PCOD?
reagard
Amit

Answered by Dr. Dattaprasad 7 hours later

answer Id 330457; conversation id 337913

Brief Answer:
Duphastan will result in period.
Detailed Answer:
Hi,
Welcome back.
Don't worry. She will get period after stopping duphastan.
If these eggs rupture, there is no problem. If they don't, they are called as cysts. These are not included in PCOD. PCOD eggs are those between 2 & 10 mm and not larger than 10 mm.
Regards.

Follow-up: Why she did not ovulate inpite of using clomifin, Provigil and Duphaston? 15 hours later

Thanks Sir.
If those eggs become cysts then what we should do for removing it.Will that affect in conceiving?
Is our line of treatment is correct? or in your opinion should we try something else for conceiving early?
Was that Provigil dose (5000 IU twice) are correct,as she had not ovulated this time and also last time ovulation was quite late.
Regards
Amit

Answered by Dr. Dattaprasad 1 hour later

answer Id 330459; conversation id 338286

Brief Answer:
Nothing to worry.
Detailed Answer:
Hi XXXXXXX
Welcome back.
If these eggs become cysts, you need not remove it. As I already told if cyst persists (that is same size or increase in size) till 3rd/4th day of her next menses, she will need a course of oral contraceptive pills to suppress them (suppression is as good as removal, same cyst won't grow again). Once cyst gets suppressed, it won't have effect on conception.
Your line of treatment is correct. You need some patience & few cycles of ovulation induction before going for further step (if no conception occurs with ovulation induction alone).
Dose of Provigil was absolutely correct. In fact single injection of 5000IU normally induces ovulation. As I told, follicle can fail to rupture occasionally & no need to worry for that. Late ovulation doesn't reduce chance of conception. For conception to occur, ovulation is important, which day it occurs is immaterial.
I hope you have already got semen checked & report is fine. If not done already, kindly get it done before proceeding for further treatment.
Regards.

Follow-up: Why she did not ovulate inpite of using clomifin, Provigil and Duphaston? 21 hours later

Thanks Sir.
I had semen examination and my semen count was 43 million/ml, but we had sex in less than 24 hours before the test.Is it okay? As we had later come to know that semen test should be done only after the gap of 48 hours of physical relation.Should I do the semen test again?
Sperm Motility:
Grade-I 25%, Grade-II 30% , Grade-III 25%, Grade-IV 20%.
Sperm Morphology:
Total Normal Sperm- 75%
Total Abnormal Sperm-25%
Our Dr. has prescribed for next sonography to be done on 2nd day of period,if previous eggs not ruptured than should she take contraceptive pill to suppress them?
If in future she faces problem in conceiving or ovulation, than when should we go for laparoscopy.(mild endometriosis or infection diagnose).
Regards
Amit

Answered by Dr. Dattaprasad 11 hours later

answer Id 330461; conversation id 338947

Brief Answer:
Semen analysis normal.
Detailed Answer:
Hi XXXXXXX
Welcome back.
If semen analysis report is normal, gap doesn't matter. In your case semen analysis report is normal, so no need to bother about gap.
Whatever your doctor has prescribed is right. As I told if cysts of so large size persist, she will need a course of contraceptive pill to suppress them.
Regarding laparoscopy, you can safely try at least 4-5 ovulatory cycles over a period of 6-7 months before going for laparoscopy. In anovulatory (PCOD) women, there is a good chance of pregnancy occurring with ovulation induction alone.
Regards.